Provider Demographics
NPI:1023248770
Name:DR HAROLD KRAJIAN OD INC
Entity type:Organization
Organization Name:DR HAROLD KRAJIAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAJIAN OD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-687-5312
Mailing Address - Street 1:9496 MAGNOLIA AVE
Mailing Address - Street 2:102
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3733
Mailing Address - Country:US
Mailing Address - Phone:951-687-5312
Mailing Address - Fax:
Practice Address - Street 1:9496 MAGNOLIA AVE
Practice Address - Street 2:102
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3733
Practice Address - Country:US
Practice Address - Phone:951-687-5312
Practice Address - Fax:951-359-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4659T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0046590Medicaid
CASD0046590Medicaid